P. Le Roux

Épidémiologie de l'asthme infantile dans la région du Havre☆

BACKGROUND: Prevalence of asthma is influenced by environmental factors which may be different from area to area. POPULATION AND METHODS: A cross-sectional epidemiological survey was carried out among 1,395 children attending primary schools in the city of Le Havre and the canton of Fecamp (Haute-Normandie). Questionnaires including data about the disease, family history, environmental and socio-economic factors were completed by the school physician in presence of the parents. RESULTS: Prevalence rate of asthma calculated from 1,193 questionnaires was 7.8%. The logistic regression curves pointed out four risk factors: family history of asthma (odds ratio: 2.52) or hay fever (OR: 1.98), atopic dermatitis (OR: 3.96), and parental smoking (OR: 1.79). Sex, socioeconomic status of parents, type of housing, presence of pets in the house were not related to prevalence of asthma. Frequency of cough during the day was only significantly different between both areas. CONCLUSIONS: The high level of school absence (21.1%) and frequency of hospitalizations for acute asthma (20.4%) should lead health professionals and educators to improve management of asthma in these areas.

Asthma control assessment in a pediatric population: comparison between GINA/NAEPP guidelines, Childhood Asthma Control Test (C‐ACT), and physician's rating

Guidelines recommend regular assessment of asthma control. The Childhood Asthma Control Test (C‐ACT) is a clinically validated tool.

La fibroscopie bronchique chez l’enfant: Expertise des centres français de pneumologie pédiatrique

INTRODUCTION Fibreoptic bronchoscopy (FB) is an important diagnostic examination in paediatric pulmonology. In 2002 the Paediatric Pulmonology and Allergy Club undertook a retrospective study to establish the current status of fibreoptic bronchoscopy among its members. METHODS In 2001 sixty five paediatric pulmonologists carried out an average of 116 examinations (+/- 111) in 35 paediatric centres. FB was performed either in an operating theatre (15 centres), a dedicated bronchoscopy suite (6 centres) or an endoscopy suite shared with gastro-enterologists (7 centres). Other examinations were performed in areas dedicated to, or associated with intensive care. General anaesthesia was routinely used in 18 centres. The others used sedation including an equimolar mixture of oxygen and nitrous oxide in 14 centres. Ten centres performed less than 50 examinations, 12 between 51 and 100, 4 between 101 and 200 and 8 centres more than 200 in the year. Seventy two per cent of the children were less than 6 years old. The washing and disinfection procedures were manual in 20 centres and automatic in 15. RESULTS Three principal indications were reported: persistent wheezing, suspicion of a foreign body and ventilatory difficulties. Cough, desaturation and fever were the most frequently reported side effects. CONCLUSIONS This is the first survey in paediatric pulmonology in France. It shows a wide variation in the practice of fibreoptic bronchoscopy in children.Resume Introduction La fibroscopie bronchique est un examen complementaire cle dans la demarche diagnostique en pneumologie pediatrique. Le Club Pediatrique de Pneumologie et d’Allergologie a realise en 2002 une enquete retrospective permettant d’etablir un etat des lieux de la pratique par les pneumopediatres de la fibroscopie bronchique. Methodes Soixante cinq pneumopediatres ont effectues en moyenne 116 examens (± 111) dans 35 centres pediatriques en 2001. Les fibroscopies ont ete realisees soit dans un bloc operatoire (15 centres), soit un bloc dedie a la fibroscopie (6 centres), soit un site partage avec les gastroenterologues (7 centres). Les autres examens ont ete pratiques dans des locaux pediatriques (salle dediee et/ou unite de soins intensifs). L’anesthesie generale a ete systematique dans 18 centres. Les autres centres ont pratique une sedation consciente, avec utilisation de melange gazeux equimolaire oxygene protoxyde d’azote dans 14 centres. Dix centres ont realise moins de 50 examens, 12 entre 51 et 100, 4 entre 101 et 200 et 8 centres plus de 200 fibroscopies dans l’annee. Soixante douze pour cent des enfants avaient moins de 6 ans. Les procedures de lavage desinfection ont ete « manuelles » dans 20 centres et automatisees dans 15 centres. Resultats Trois indications principales ont ete rapportees : respiration sifflante persistante, suspicion de corps etranger et troubles de ventilation. Parmi les effets indesirables, la toux, la desaturation en oxygene et la fievre ont ete le plus souvent rapportees. Conclusion Cette enquete est une premiere en pneumologie pediatrique en France. Elle montre l’heterogeneite des pratiques en matiere de fibroscopie bronchique chez l’enfant.

Asthme du nourrisson et du jeune enfant

Many studies have been dedicated to the prevention of infant and childhood asthma in recent years. Primary prevention begins during intra uterine life (maternal smoke, diet, allergen exposure). During the first year of life, prolonged breastfeeding has been found to be a protective factor against the development of allergy and asthma. The role of infections and lifestyle is controversial and it is not clear whether these factors reduce or increase the risk of asthma. Environmental measures such as avoidance of tobacco smoke and reducing allergens exposure must be recommended to infants with high risk of asthma.

Recommandations sur l’utilisation des nouveaux outils diagnostiques étiologiques des infections respiratoires basses de l’enfant de plus de trois mois

Recommendations for the use of diagnostic testing in low respiratory infection in children older than 3 months were produced by the Groupe de Recherche sur les Avancées en Pneumo-Pédiatrie (GRAPP) under the auspices of the French Paediatric Pulmonology and Allergology Society (SP(2)A). The Haute Autorité de santé (HAS) methodology, based on formalized consensus, was used. A first panel of experts analyzed the English and French literature to provide a second panel of experts with recommendations to validate. Only the recommendations are presented here, but the full text is available on the SP(2)A website.

P508 - Motivation des consultations aux urgences pédiatriques

Objectif etudier la motivation du recours aux urgences et la place du medecin traitant. Etude prospective du 30 mars au 6 avril 2009. Le questionnaire portait sur le patient, son environnement social, le motif de consultation et le parcours de soins des enfants. Sur 633 passages, 78,5 % questionnaires analyses. Dans la population, 16,6 % avaient la CMU. Motifs traumatismes (34,4 %), fievre (14,5 %), troubles digestifs et respiratoires. Les patients consultaient d’eux-memes dans 75,1 % des cas. Adressage par un medecin (10,7%). Dans 29,6 % des cas, ils avaient deja consulte le medecin dans les 24 heures. Les motivations : faire des examens (23,7 %), inquietude (19,2 %), presence de specialiste (15,3 %). La dispense de l’avance du tiers payant n’etait pas un argument important dans le choix des urgences. Dans 57,6 % des cas, les patients consultaient au moins pour la deuxieme fois en un an aux urgences. Il y a eu 11,1 % d’hospitalisation cette semaine-la ; ce taux etait de 26 % chez les patients adresses. Les motifs de consultations relevent souvent de la medecine generale et auraient pu etre pris en charge en ville par le medecin traitant. Mais les parents cherchent une reponse rapide, avec une prise en charge de leur enfant a des horaires compatibles avec leur mode de vie.

Mémoire originalLes conseils téléphoniques aux urgences pédiatriques : expérience du centre hospitalier du HavrePediatric telephone advice in the emergency department

Objectives. – To describe the activity of telephone advice in a pediatric emergency department and assess the influencing factors to improve quality of care. Methods. – Descriptive study about all the anonymous telephone calls received on the direct line of the pediatric emergency room of Le Havre hospital, from 25 January to 25 July 2002, and all the advices given by a doctor or a nurse. Results. – The mean daily call frequency was 2.15 (0–12) with 586 calls during the 6 months period and the mean call duration was 3 min (1–20). Parents took telephone advices for: fever (27%), digestive troubles (22%), and trauma (14%). We found no difference concerning symptoms according to season. The rush hours were, on a bimodal graph, 0–1 am and 8–9 pm, paralleling the rush activity of consultation in pediatric emergency room. The heavy days for phone advices during the week were Tuesday and Wednesday. We found no correlation between heavy days of week and phone call duration. Thirty percent of cases did not need any advice because the asks were only an orientation advice. Advice to go to our emergency department was done in 11% of orientation advice. The call duration was significantly longer for: (1) calls including several symptoms or griefs, (2) calls given by a nurse; (3) calls taking place during hours of lowest activity in the emergency room (between 6 and 12 am), (4) calls including advice about medication or diet; (5) calls for counselling an orientation other than medical establishment. Conclusion. – Our assessment of telephone call advices represented the first step to improve the quality of answer to families. Next step will be written protocols to answer more adequately to main griefs and symptoms that lead families to search for phone counselling.

Les conseils téléphoniques aux urgences pédiatriques : expérience du centre hospitalier du Havre

Objectives. – To describe the activity of telephone advice in a pediatric emergency department and assess the influencing factors to improve quality of care. Methods. – Descriptive study about all the anonymous telephone calls received on the direct line of the pediatric emergency room of Le Havre hospital, from 25 January to 25 July 2002, and all the advices given by a doctor or a nurse. Results. – The mean daily call frequency was 2.15 (0–12) with 586 calls during the 6 months period and the mean call duration was 3 min (1–20). Parents took telephone advices for: fever (27%), digestive troubles (22%), and trauma (14%). We found no difference concerning symptoms according to season. The rush hours were, on a bimodal graph, 0–1 am and 8–9 pm, paralleling the rush activity of consultation in pediatric emergency room. The heavy days for phone advices during the week were Tuesday and Wednesday. We found no correlation between heavy days of week and phone call duration. Thirty percent of cases did not need any advice because the asks were only an orientation advice. Advice to go to our emergency department was done in 11% of orientation advice. The call duration was significantly longer for: (1) calls including several symptoms or griefs, (2) calls given by a nurse; (3) calls taking place during hours of lowest activity in the emergency room (between 6 and 12 am), (4) calls including advice about medication or diet; (5) calls for counselling an orientation other than medical establishment. Conclusion. – Our assessment of telephone call advices represented the first step to improve the quality of answer to families. Next step will be written protocols to answer more adequately to main griefs and symptoms that lead families to search for phone counselling.

La fibroscopie bronchique chez l’enfant

INTRODUCTION Fibreoptic bronchoscopy (FB) is an important diagnostic examination in paediatric pulmonology. In 2002 the Paediatric Pulmonology and Allergy Club undertook a retrospective study to establish the current status of fibreoptic bronchoscopy among its members. METHODS In 2001 sixty five paediatric pulmonologists carried out an average of 116 examinations (+/- 111) in 35 paediatric centres. FB was performed either in an operating theatre (15 centres), a dedicated bronchoscopy suite (6 centres) or an endoscopy suite shared with gastro-enterologists (7 centres). Other examinations were performed in areas dedicated to, or associated with intensive care. General anaesthesia was routinely used in 18 centres. The others used sedation including an equimolar mixture of oxygen and nitrous oxide in 14 centres. Ten centres performed less than 50 examinations, 12 between 51 and 100, 4 between 101 and 200 and 8 centres more than 200 in the year. Seventy two per cent of the children were less than 6 years old. The washing and disinfection procedures were manual in 20 centres and automatic in 15. RESULTS Three principal indications were reported: persistent wheezing, suspicion of a foreign body and ventilatory difficulties. Cough, desaturation and fever were the most frequently reported side effects. CONCLUSIONS This is the first survey in paediatric pulmonology in France. It shows a wide variation in the practice of fibreoptic bronchoscopy in children.Resume Introduction La fibroscopie bronchique est un examen complementaire cle dans la demarche diagnostique en pneumologie pediatrique. Le Club Pediatrique de Pneumologie et d’Allergologie a realise en 2002 une enquete retrospective permettant d’etablir un etat des lieux de la pratique par les pneumopediatres de la fibroscopie bronchique. Methodes Soixante cinq pneumopediatres ont effectues en moyenne 116 examens (± 111) dans 35 centres pediatriques en 2001. Les fibroscopies ont ete realisees soit dans un bloc operatoire (15 centres), soit un bloc dedie a la fibroscopie (6 centres), soit un site partage avec les gastroenterologues (7 centres). Les autres examens ont ete pratiques dans des locaux pediatriques (salle dediee et/ou unite de soins intensifs). L’anesthesie generale a ete systematique dans 18 centres. Les autres centres ont pratique une sedation consciente, avec utilisation de melange gazeux equimolaire oxygene protoxyde d’azote dans 14 centres. Dix centres ont realise moins de 50 examens, 12 entre 51 et 100, 4 entre 101 et 200 et 8 centres plus de 200 fibroscopies dans l’annee. Soixante douze pour cent des enfants avaient moins de 6 ans. Les procedures de lavage desinfection ont ete « manuelles » dans 20 centres et automatisees dans 15 centres. Resultats Trois indications principales ont ete rapportees : respiration sifflante persistante, suspicion de corps etranger et troubles de ventilation. Parmi les effets indesirables, la toux, la desaturation en oxygene et la fievre ont ete le plus souvent rapportees. Conclusion Cette enquete est une premiere en pneumologie pediatrique en France. Elle montre l’heterogeneite des pratiques en matiere de fibroscopie bronchique chez l’enfant.

Erratum à l’article « Recommandations sur l’utilisation des nouveaux outils diagnostiques étiologiques des infections respiratoires basses de l’enfant de plus de trois mois » [Arch. Pediatr. 21(4) (2014) 418–423]

V. Houdouina,*,1, G. Pouesselb,s,1, F. Angoulvantc,1, J. Brouardd,1, J. Derellee, M. Fayonf,1, A. Ferronig,1, J.-P. Gangneuxh,1, I. Haui,1, M. Le Bourgeoisj,1, M. Lorrotk,1, J. Menottil,1, N. Nathanm,1, A. Vabretn,1, F. Walleto,1, S. Bonacorsip,2, R. Cohenq,2, J. de Blicr,2, A. Deschildres,2, V. Gandemert,2, I. Pinu,2, A. Labbev,2, P. Le Rouxw,2, A. Martinotx,2, B. Rammaerty,2, Groupe de recherche sur les avancees en pneumo-pediatrie (GRAPP), J.-C. Dubusz, C. Delacourtaa, C. Marguetab Recu le : 27 mai 2014 Accepte le : 27 mai 2014 Disponible en ligne 1er juillet 2014